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Administration Officials Continue to Push for Value-Based Care in Speeches to Hospital Executives; ASCRS and the Alliance of Specialty Medicine Continue to Advocate to Retain a Viable Medicare Fee-for-Service Option

This week, both Health and Human Services Secretary (HHS) Alex Azar and CMS Administrator Seema Verma addressed the annual meeting of the American Hospital Association in Washington, D.C. Secretary Azar restated his support for value-based healthcare, such as alternative payment models, and previewed the upcoming Trump administration announcement to tackle drug prices during his speech and highlighted recent HHS efforts to increase hospital price transparency and give patients access to their data.

In her speech to the hospital executives, Administrator Verma announced that the Center for Medicare and Medicaid Innovation (CMMI) would be putting out a series of new value-based models this year based on feedback from a request for information (RFI) issued late last year. When it was released, ASCRS responded to the RFI and urged CMS to maintain options for physicians who do not have the option to participate in APMs like most ophthalmologists to remain in a viable fee-for-service system. In addition, we recommended CMS create a demonstration project to test a viable Medicare private contracting option. Administrator Verma also noted in her speech this week that the agency will be seeking ways to move more Accountable Care Organizations (ACOs) to incorporate two-sided risk, modifying Stark Law regulations to accommodate some APMs, possibly modifying the payment structure for Part B drugs administered in the office, and seeking further opportunities to reduce regulatory burden.

ASCRS and the Alliance of Specialty Medicine continue to push back on the administration’s efforts to move all physicians into value-based payment models, such as APMs, and advocate that physicians must continue to have a viable Medicare fee-for-service option. There are very few options for specialists to participate in APMs currently—and no ophthalmology-specific models at all. In addition, many specialists, such as ophthalmologists, do not coordinate care with other physicians, which is generally the goal of many existing primary care-focused models. We are seeking a meeting with Secretary Azar in the coming weeks to voice our concerns.